Provider Demographics
NPI:1013958230
Name:JAIN, SHUBHA M (MD)
Entity type:Individual
Prefix:
First Name:SHUBHA
Middle Name:M
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 8000
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8000
Mailing Address - Country:US
Mailing Address - Phone:818-366-0474
Mailing Address - Fax:818-474-7530
Practice Address - Street 1:11177 TAMPA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91226-2254
Practice Address - Country:US
Practice Address - Phone:818-366-0474
Practice Address - Fax:818-474-7530
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54399207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40621Medicare UPIN
CAA54399Medicare ID - Type Unspecified